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Device for incising a blood vesselRelated Patent Categories: Surgery, Instruments, Blood Vessel, Duct Or Teat Cutter, Scrapper Or AbraderDevice for incising a blood vessel description/claimsThe Patent Description & Claims data below is from USPTO Patent Application 20060095056, Device for incising a blood vessel. Brief Patent Description - Full Patent Description - Patent Application Claims
BACKGROUND OF THE INVENTION [0001] 1. Field of Invention [0002] The invention relates to the field of medical instruments, and more particularly, to a device for creating an incision in a hollow lumen, such as an artery or vein. [0003] 2. Description of Related Art [0004] In many surgical procedures, a surgeon must make a substantially linear incision in a hollow structure having a lumen, such as a blood vessel. For example, the creation of an incision is generally the first step in creating a new blood flow path that bypasses a blockage or stenosis within an artery. In such a bypass procedure, a graft vessel, which can be a vein or an artery or a synthetic tube, is connected or anastomosed to the target vessel downstream the blockage or stenosis. The graft vessel acts as a conduit to take blood from its natural, unobstructed origin, and permit it to flow through the anastomosis to the target vessel at a location downstream of the original obstruction. Alternatively, the graft may be severed from its natural origin, and may be anastomosed to another, big blood vessel such as the aorta to take blood from. Where the bypassed vessel is a coronary artery, the procedure is known as coronary artery bypass graft (CABG) surgery. The connection made at the aorta is referred to as the proximal anastomosis and the connection or connections made at the coronary artery downstream of the obstruction is referred to as the distal anastomosis. The anastomosis can be end-to-side, requiring a side hole, generally made by a precise incision in the target vessel only, or can be side-to-side, requiring matched incisions in both the target vessel and the graft vessel. [0005] A successful bypass graft creates blood flow to a previously blocked or substantially blocked artery. To maintain the new flow path, the anastomosis or connection between the graft vessel and the coronary or target vessel, must provide a smooth transition from the graft vessel to the target vessel. A poorly created incision may result in loose intimal flaps that create turbulence and obstruction with secondary thrombus formation at the anastomosis site, which in turn induces smooth muscle cell migration to the site as part of the body healing response. This healing response may lead to stenosis or a blocking of the anastomosis and associated artery. In addition, the incision must completely penetrate a portion of one side of the wall of the artery to create an opening without damaging any other tissue, such as the back wall of the artery near the site of the incision. [0006] Further, the incision needs to be straight, uniform and of a defined length as the opening created by the incision is sized to communicate with the inner lumen of the graft vessel that the surgeon connects to the opening in the coronary vessel. This is particularly true when the surgeon uses an automatic anastomosis device to facilitate the creation of the anastomosis. In such a procedure, rather than hand sewing the graft vessel to the target vessel, the surgeon uses an anastomosis device or connector to make the connection. These connector devices can provide the benefit of a quicker, and potentially more reliable anastomosis, than a hand sewn anastomosis, even under limited access conditions. However, such connector devices are sized for a particular graft and target vessel and, as such, a particular incision length. Thus, it will be clear that a uniform, quality incision is desirable, whether the anastomosis is hand sewn or created with a connector, but an incision with a precisely defined, consistent length is even more desirable when the anastomosis relies on a connector. [0007] The standard method for creating an incision in a cardiac vessel requires that the surgeon first pierce the vessel with a small scalpel to create a stab wound, for example using a scalpel having a 15 degree tip, like a Sharpoint.RTM. scalpel (Sharpoint Inc., Reading Pa.). The surgeon then may push the scalpel into the vessel lumen and enlarge the stab wound by cutting the vessel wall with the scalpel blade using an inside-out motion. During this step, the surgeon has to take particular care not to damage the back side of the vessel (referred to as "backwalling"). The surgeon then typically uses micro scissors to cut the arteriotomy to a desired length by extending the initial incision in one or both directions. [0008] The creation of a uniform incision of a defined length is a difficult task when the surgeon uses a scalpel and micro scissors. As it is micro scissors generally do not make incisions of a consistent quality across the length of the incision they create. Practically, the incision created in the tissue cut near the tip of the micro scissors may often not be the same as the quality of the incision in the tissue cut near the pivot point of the micro scissors. Specifically, tissue cut at the tip of the micro scissors may be crushed, rather than neatly cut. This problem is caused at least in part because the cutting angle between the jaws of the scissors gradually decreases to almost zero near the tip as the cutting edges of opposing scissor blades assume a near parallel position during the cutting action, an issue intrinsically related to the pivotable nature of how a pair of scissors works. A small cutting angle stresses the mechanical parts of the micro scissors, and can lead to a failure to cut tissue. [0009] To further complicate the procedure, where the surgery is performed on a beating heart, the surgical field is small, creating access issues that make it difficult for the surgeon to precisely manipulate the instruments, especially when attempting to anastomose to an artery on the posterior or inferior wall of the heart. Surgeons also do not typically have an accurate means of measuring the required arteriotomy size so it is difficult to precisely cut the intended length. Surgeons therefore rely on their subjective estimation of the desired arteriotomy length. The length of an arteriotomy created in this manner has been shown to be highly variable and inaccurate. [0010] Where the surgeon determines that the length of the initial incision is too short, the surgeon will be required to lengthen the incision by again using micro scissors or a scalpel to cut the tissue. The use of these types of tools a second time creates the possibility that the resulting incision will not be aligned with the initial incision along with the attendant deficiencies of using the micro scissors discussed above. [0011] Where a surgeon uses an anastomosis device, if the surgeon determines that the length of the incision is too long while performing an end-to-side anastomosis or a side-to-side anastomosis, then the surgeon can add additional stitches to close the remaining incision around the anastomotic device. This type of repair causes its own problems, as any additional suturing devaluates the benefit of an automated anastomotic system, requires access for carefully manipulated instruments, and last, but not least, may increase the likelihood of stenosis, due to a reduction in diameter or due to the body's healing response to an injury. [0012] Where a surgeon hand sews an anastomosis, if the surgeon determines that the length of the incision is too long, especially while performing a side-to-side anastomosis where the graft vessel and the target vessel cross one another at an angle of 90.degree. (a "diamond-shaped anastomosis") and the graft vessel is anastomosed to more than one coronary artery (a "jump graft"), then the problem is more critical. Where this occurs, the surgeon is left with a difficult decision. Either suture the incision to shorten it and thereby risk diameter reduction and stenosis. Or, alternatively, connect the graft at the overly long incision, and risk that the graft vessel may flatten to accommodate the lengthy incision (the "seagulling" phenomenon), which may cause the graft vessel to effectively close off at the anastomosis site, thus putting both the current and all existing downstream both the current and all existing at risk. BRIEF SUMMARY OF THE INVENTION [0013] The present invention addresses the shortcomings of the prior art by providing an improved device for creating an incision. [0014] The described device is designed to create reliably and consistently a quality. arteriotomy or venotomy, or incision in any other tubular natural or synthetic structure, of a defined length. An arteriotomy is an incision in the wall of an artery reaching the lumen, while a venotomy is such an incision in case of a vein. While the device is designed for use in human coronary arteries and arterial as well as venous bypass grafts during CABG, those skilled in the art understand the embodiments described herein have broader application in creating an incision in any hollow tissue structure, such as the intestines, the bladder, the ureter, other types of blood vessels, or other similar tubular structures. [0015] According to the present invention, an device for incising a blood vessel includes at least one gripping portion, a stationary blade attached to the gripping portion that has a neck and a foot connected to the neck. The foot has a cutting edge along an upper surface. The device includes a relatively blunt moving blade having a leading edge and which is operatively movable with respect to the stationary blade. The moving blade has a first position, proximal to the upper surface of the stationary blade, and is movable to a second position, distal to the upper surface of the stationary blade, to cut tissue disposed between the upper surface of the stationary blade and the leading edge of the moving blade. [0016] A method for making an incision in the wall of a hollow tissue structure that has an outer surface, an inner surface and a lumen, includes the steps of: (a) providing a device having a first blade, the first blade having a cutting edge along an upper surface, and a relatively blunt second blade having a leading edge, the moving blade being movable relative to the first blade from a first position, where the leading edge of the second blade is proximal to the upper surface of the first blade, to a second position, where the leading edge of the second blade is distal to the upper surface of the first blade; (b) incising the outer surface to create a small incision in the wall; (c) passing at least the cutting edge of the first blade through the small incision and into the lumen; and (d) creating a larger incision in the wall by using the first blade in cooperation with the second blade to cut from the inner surface to the outer surface when the second blade moves from the first position to the second position. BRIEF DESCRIPTION OF THE DRAWINGS [0017] These and other features, advantages and benefits will be made apparent through the following descriptions and accompanying figures, where like reference numerals refer to the same features across the various drawings. [0018] FIG. 1 is a perspective view of a device for incising a blood vessel according to the present invention; [0019] FIG. 2 is an exploded view of the device for incising a blood vessel of FIG. 1; [0020] FIGS. 3(a)-(c) are, respectively, a top plan view, a side cross-sectional view of FIG. 3(a) taken along line 3(b)-3(b), and an end view of the stationary blade of the device for incising a blood vessel of FIG. 1; [0021] FIG. 4 is the preferred embodiment of the foot of the stationary blade of the current invention; Continue reading about Device for incising a blood vessel... Full patent description for Device for incising a blood vessel Brief Patent Description - Full Patent Description - Patent Application Claims Click on the above for other options relating to this Device for incising a blood vessel patent application. ###  How KEYWORD MONITOR works... a FREE service from FreshPatents1. Sign up (takes 30 seconds). 2. Fill in the keywords to be monitored. 3. Each week you receive an email with patent applications related to your keywords. Start now! - Receive info on patent apps like Device for incising a blood vessel or other areas of interest. ### Previous Patent Application: Device for incising a blood vessel Next Patent Application: Safety scalpel Industry Class: Surgery ### FreshPatents.com Support Thank you for viewing the Device for incising a blood vessel patent info. IP-related news and info Results in 0.38932 seconds Other interesting Feshpatents.com categories: Tyco , Unilever , Warner-lambert , 3m 174 |
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